Provider Demographics
NPI:1245004688
Name:POUDEL, PRABIN
Entity type:Individual
Prefix:
First Name:PRABIN
Middle Name:
Last Name:POUDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 COUTANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5236
Mailing Address - Country:US
Mailing Address - Phone:216-394-8699
Mailing Address - Fax:
Practice Address - Street 1:1593 COUTANT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5236
Practice Address - Country:US
Practice Address - Phone:216-394-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty